Provider tendencies important to readmissions as well as patient characteristics

A new study indicates that in some regions, healthcare providers use hospitals more often than others for care of all types, including readmitting patients within 30 days of their discharge after treatment for a heart attack.

Published in the Journal of the American Heart Association, the Dartmouth Atlas Project’s study reviewed the records of more than 185,000 Medicare patients in more than 1,000 hospitals and health systems across the country. Each facility had at least 50 patients discharged after an acute myocardial infarction during the study period. The study explored the links between readmission rates for those patients and measures of quality, capacity and intensity of care for the hospitals and in the region.

Better discharge planning and larger hospital size were associated with lower 30-day readmission rates after a patient experienced a heart attack between 2008 and 2009, according to the results. When the investigators examined each hospital’s intensity to admit other patients during their last six months of life, however, they found that the intensity of hospital care for patients in the last six months of life in 2007 (a year prior to the heart attack readmissions) were also significantly associated with higher 30-day readmission rates.

End-of-life care intensity was measured by how many days patients at the end of life spent in the hospital and in intensive care units, total number of physicians seen, and how many patients were seeing more than 10 different physicians. Higher rates of all medical admissions and the local supply of primary care physicians and cardiologists also were significantly associated with increased 30-day readmissions.  

“It’s important that hospitals continue to improve care transitions, including improved discharge instructions and follow-up care,” said Jeremiah Brown PhD, MS, the study’s author and postdoctoral fellow at The Dartmouth Institute for Health Policy & Clinical Practice. “However, every hospital has its own signature of intensity of healthcare. Current efforts to reduce readmission rates fail to target these more general health system effects. To fully understand the problem we need to recognize the influence of local patterns in hospital utilization irrespective of discharge planning, care coordination, and treating patients intensely at the end of life.”

Access the study.